Glucocorticoids (steroids) are widely used across many medical specialities for their anti-inflammatory and immunosuppressive properties. However, one of their major side effects is the development of hyperglycaemia. It is well recognized that high glucose levels in people with diabetes in hospital are associated with harm and increased lengths of hospital stay. The use of glucocorticoid (steroid) treatment in people with pre-existing diabetes will undoubtedly result in worsening glucose control, and this may be termed 'steroid-induced hyperglycaemia', and will warrant temporary additional, and more active, glycaemic management. A rise in glucose may occur in people without a known diagnosis of diabetes, and this may be termed 'steroid-induced diabetes'. There is a lack of evidence to guide how people with hyperglycaemia should be managed, and much of the guidance given here is a consensus based on best practice collated from around the United Kingdom. Where evidence is available, this is referenced. These guidelines on the management of people with diabetes treated with steroids has been adapted specifically for Diabetic Medicine. The full version of the guidelines can be found on line at: www.diabetes.org.uk/joint-british-diabetes-society or https://abcd.care/joint-british-diabetes-societies-jbds-inpatient-care-group.

To evaluate the impact of a Diabetes Specialist Nurse prescriber on insulin and oral hypoglycaemic agent medication errors and length of stay. 2 BackgroundThe National Health Service has committed to a 40% reduction in the number of drug errors in the use of prescribed medicines. Drug errors in diabetes care are a common cause of significant morbidity and complications. Nurse prescribing creates an opportunity for nurses to improve care for these patients. DesignA quasi-experiment using six wards in a single hospital trust. MethodsIn-patient care of a convenience sample of patients with diabetes was evaluated before (n=27) and after (n=29) the intervention of a Diabetes Specialist Nurse prescriber.Prospective data was collected to measure insulin and oral hypoglycaemic medication errors and length of stay. ResultsThere was a significant reduction in the total number of errors between the preintervention and intervention group (mean reduction 21 errors) (p=0.016). The median length of stay was reduced by three days. The total number of errors and length of stay were affected by admission category (p=0.0004). ConclusionsA medicines management intervention, provided by a Diabetes Specialist Nurse prescriber, had a positive effect on the system of delivering medicines to patients with diabetes, and significantly reduced the number of errors. This reduction had some 3 effect on length of stay. The cost saving was sufficient to finance a Diabetes Specialist Nurse prescriber post. Relevance to Clinical Practice Errors frequently occur in the prescription and administration of medicines to patients with diabetes  The education of healthcare professionals is a factor contributing to these errors. Nurse prescribing provides a new system by which to educate patients and staff about their medicines. A Diabetes Specialist Nurse prescriber can reduce insulin and oral hypoglycaemic agent medication errors. This reduction had some effect on length of stay.

Management of type 2 diabetes mellitus (T2DM) is complex and challenging, particularly for clinicians working in primary care who are faced with many competing clinical priorities. The range of available T2DM treatments has diversified significantly in recent years, generating a busy and data-rich environment in which evidence is rapidly evolving. Sodium-glucose cotransporter-2 inhibitor (SGLT2i) agents are a relatively new class of oral glucose-lowering therapy that have been available in the UK for approximately 5 years. These agents reduce the reabsorption of glucose in the kidney and increase its excretion via the urine. Conflicting messages and opinions within the clinical community have led to misconceptions concerning the efficacy, safety and appropriate position of SGLT2i therapies within the T2DM treatment pathway. To help address some of these concerns and provide advice regarding the appropriate place of these medicines in clinical practice, the Improving Diabetes Steering Committee was formed. The Committee worked together to develop this review article, providing a summary of relevant data regarding the use of SGLT2i medicines and focusing on specific considerations for appropriate prescribing within the T2DM management pathway. In addition, a benefit/risk tool has been provided (see Fig. 3) that summarises many of the aspects discussed in this review. The tool aims to support clinicians in identifying the people most likely to benefit from SGLT2i treatments, as well as situations where caution may be required.FundingNapp Pharmaceuticals Limited.Electronic supplementary materialThe online version of this article (10.1007/s13300-018-0471-8) contains supplementary material, which is available to authorized users.

The DSN role has evolved since 2000 to include complex service provision and responsibilities including specialist clinics, education of healthcare professionals and patients. The lack of substantive contracts and protected study leave may compromise these roles in the future.

Paediatric and adolescent diabetes services are rising to the challenge of providing high-quality care despite rising prevalence and increasingly complex insulin regimes. Services have improved in a number of key areas but serious deficiencies remain.

Cardiovascular disease (CVD), including heart failure (HF), is a leading cause of morbidity and mortality in people with type 2 diabetes mellitus (T2DM). CVD and T2DM share common risk factors for development and progression, and there is significant overlap between the conditions in terms of worsening outcomes. In assessing the cardiovascular (CV) safety profiles of anti-diabetic drugs, sodium-glucose cotransporter-2 inhibitor (SGLT2i) therapies have emerged with robust evidence for reducing the risk of adverse CVD outcomes in people with T2DM who have either established CVD or are at risk of developing CVD. A previous consensus document from the Improving Diabetes Steering Committee has examined the potential role of SGLT2is in T2DM management and considered the risk-benefit profile of the class and the appropriate place for these medicines within the T2DM pathway. This paper builds on these findings and presents practical guidance for maximising the pleiotropic benefits of this class of medicines in people with T2DM in terms of Enhanced Digital Features To view enhanced digital features for this article go to https://doi.org/10.6084/ m9.figshare.8276270.

Diabetic nephropathy remains the principal cause of end-stage renal failure in the UK and its prevalence is set to increase. People with diabetes and end-stage renal failure on maintenance haemodialysis are highly vulnerable, with complex comorbidities, and are at high risk of adverse cardiovascular outcomes, the leading cause of mortality in this population. The management of people with diabetes receiving maintenance haemodialysis is shared between diabetes and renal specialist teams and the primary care team, with input from additional healthcare professionals providing foot care, dietary support and other aspects of multidisciplinary care. In this setting, one specialty may assume that key aspects of care are being provided elsewhere, which can lead to important components of care being overlooked. People with diabetes and end-stage renal failure require improved delivery of care to overcome organizational difficulties and barriers to communication between healthcare teams. No comprehensive guidance on the management of this population has previously been produced. These national guidelines, the first in this area, bring together in one document the disparate needs of people with diabetes on maintenance haemodialysis. The guidelines are based on the best available evidence, or on expert opinion where there is no clear evidence to inform practice. We aim to provide clear advice to clinicians caring for this vulnerable population and to encourage and improve education for clinicians and people with diabetes to promote empowerment and self-management.

The aim of this study was to evaluate the impact of a diabetes specialist nurse (DSN) prescriber on insulin and oral hypoglycaemic agent medication errors, length of hospital stay, and patients' ability to self‐manage their diabetes whilst in hospital. The setting was six wards in a single United Kingdom district general hospital trust. The standard in‐patient care of a convenience sample of diabetic patients treated with insulin and/or oral hypoglycaemic agents was evaluated before (n = 187) and after (n = 265) the intervention of a DSN prescriber. Prospective data were collected in order to measure insulin and oral hypoglycaemic medication errors, and length of stay (i.e. primary outcome measures). A secondary outcome, the extent to which patients felt able to manage their care, was measured using a self‐report questionnaire. The results showed that the median number of insulin and oral hypoglycaemic agent medication errors was lower in the intervention group (four vs six, p<0.01). The median length of stay was less for patients in the intervention group (seven vs nine days, p<0.05). In all, 61% (59/96) of patients in the pre‐intervention group, compared with 71% (90/126) of patients in the intervention group (p = 0.118), reported that they were able to manage their diabetes during their hospital stay. It was concluded that a DSN prescriber reduced prescribing errors. This reduction had some effect on length of stay. The cost saving was at least sufficient to self‐finance the cost of a DSN prescriber post. Copyright © 2007 John Wiley & Sons.